Specimen

STATEMENT IN LIEU OF CERTIFICATE OF NON-IMPEDIMENT Name............................, a citizen of Canada, of address..................................., in the city of .............................., in the province (territory) of .................................., who intends to marry name.............................., a citizen of the Czech Republic, has applied to the Department of Foreign Affairs for a Certificate to the effect that according to the Canadian authorities there exists no impediment to such marriage. Canadian law neither requires nor provides for the issuance of such certificate. Therefore, the Department is not in a position to issue the Certificate required. This statement, however, is given in the event that it may be of relevance should the authorities of the country concerned be prepared to consider a waiver of the production of the requested Certificate. (oval stamp and signature of the Foreign Affairs Canada)

Ottawa, Date Deputy Minister of Foreign Affairs Note: You can try to receive a similar "statement" at the Canadian Embassy in Prague Instructions: 1. This is just a specimen for your information, you cannot use it. Original document is issued only by the Foreign Affairs Canada (FAC), 125 Sussex Drive, Ottawa, Ont. K1A 0G2, phone: (613) 995-0119. Kindly contact this office and ask for this document and its authentification. Processing time is ten (10) days. 2. Send or bring the original document issued and authentificated by FAC to the Embassy or Consulate General of the Czech Republic and ask for its superlegalization. 3. Translate this page into the Czech language (you can use the specimen translation on the next page). 4. Take the document with you to the Czech Republic and submit it to authorities at a City Hall or a church, where you want your wedding ceremony to be concluded.

VZOR

Specimen PROHLEN VYDAN NA DOST O VYSTAVEN POTVRZEN O PRVN ZPSOBILOSTI K UZAVEN SATKU Jmno..................................................... kanadsk oban, bytem adresa......................., provincie................................................., Kanada, podal Ministerstvo zahraninch vc Kanady o potvrzen o prvn zpsobilosti k plnovanmu uzaven manelstv s obankou/obanem esk republiky jmno.......................................... Kanadsk prvo nevyaduje ani neupravuje vydn takovho potvrzen. Ministerstvo zahraninch vc Kanady nen proto zpsobil toto potvrzen vystavit. Toto prohlen se vak in pro ppad, e me bt relevantn pro orgny pslun zem (takov potvrzen vyadujc), pokud by tyto byly pipraveny zvit uputn od poadavku pedloen poadovanho potvrzen (o prvn zpsobilosti k uzaven manelstv).

Kulat raztko a podpis Ministerstva zahraninch vc Kanady

V Ottaw, datum

Nmstek ministra zahraninch vc Instructions: 1. Fill the dotted spaces using your personal data and details from the original English text document (see previous page for details how to obtain one), then erase dots and text in Italic. 2. Erase the text below the horizontal line (including the line), and then print out the page. 3. Send or bring this page to the Embassy or Consulate General of the Czech Republic and ask for verification of the translation of this document. 4. Take this page with you to the Czech Republic and submit it to authorities at a City Hall or a church, where you want your wedding ceremony to be concluded.